Provider Demographics
NPI:1346794989
Name:HOLMSTEAD, MIRANDA JANE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:JANE
Last Name:HOLMSTEAD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:JANE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7550 S BLACKHAWK ST
Mailing Address - Street 2:APT 5204
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4068
Mailing Address - Country:US
Mailing Address - Phone:801-300-0314
Mailing Address - Fax:
Practice Address - Street 1:7550 S BLACKHAWK ST
Practice Address - Street 2:APT 5204
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-4068
Practice Address - Country:US
Practice Address - Phone:801-300-0314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14089966235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist